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General NPI Number Information
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NPI Number | 1588957500
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Entity Type | Organization
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Legal Business Name | MICHAEL B. RUSSO, MD, INC
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Dates
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Enumeration Date | 05/24/2011
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Last Update Date | 12/10/2024
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Provider Practice Location Address
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Address Line | 320 WARD AVE STE 107
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City | HONOLULU
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State | HI
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Zip | 96814-4016
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Country | US
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Telephone | 808-294-3332
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Fax | 808-748-2920
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Provider Business Mailing Address
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Address Line | 320 WARD AVE STE 107
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City | HONOLULU
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State | HI
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Zip | 96814-4016
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Country | US
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Telephone | 808-294-3332
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Fax | 808-748-2920
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Authorized Official
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Title or Position | OWNER, DOCTOR
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Name | DR. MICHAEL BRIAN RUSSO
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Credential | M.D
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Telephone | 301-775-8731
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 14968
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License Number State | HI
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